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Program takes health care to the streets

Malama I Ke Ola brings aid to people who can’t make it to a clinic

Malama I Ke Ola Health Center staff RN Charlotte Jones (from right) and volunteer nurse Young Seroy apply bandages to Larry Makaena’s leg during Wednesday’s Street Medicine clinic at Lahaina Baptist Church. “All these people who are helping us, they are true angels,” Makaena said. The program aims to bring health care directly to the unsheltered with services such as wound care, assessments and help coordinating virtual doctor’s visits. The Maui News / MATTHEW THAYER photos

Recognizing the need for providing medical and social services to those without care, a home, financial stability or transportation, Malama I Ke Ola Health Center created a program that brings health care directly to the unsheltered population on Maui.

The Street Medicine Program, which serves houseless individuals in Kihei, Kahului and Lahaina, is made up of three team members who provide direct wound care, offer assessments, coordinate primary care visits via telehealth and more.

“So what we’re trying to do is, number one, build trust within the unsheltered community to let them know that we are here to service them,” said Program Manager Risa Yarborough on Tuesday via phone. “It is our mission to serve the underserved and to create equal access, which means that, ‘I understand that you had this negative experience with health care previously or you’re just unable to access it yourself, so here we are to help you do that.’ “

She added that staff want to help them to “live the best quality of life that you want to live.”

AlohaCare, a nonprofit health plan for Hawaii’s QUEST Integration (Medicaid) and Medicare beneficiaries, provided a $35,000 Access to Care grant in December to help Malama I Ke Ola continue its outreach program.

Maui Outreach Mission Outreach Leader Jelena Dackovic helps a man with paperwork at Wednesday’s clinic in Lahaina.

“It was such a miracle, my goodness, I don’t know what else to say,” Yarborough said. “Initially, we were able to start it up with CARES Act funds, and then as the funds ran out, we weren’t going to be able to fund the (registered nurse) position that actually goes out to provide the wound care and telehealth services.”

AlohaCare’s CEO Francoise Culley-Trotman said that Malama I Ke Ola is “extremely innovative.”

“Our goal was to really support that innovation and their approaches to health care delivery because it focuses on the needs of the community,” Culley-Trotman said Wednesday. “They’re phenomenal, they know their community really well and they’re delivering care exactly where the homeless population is versus waiting for them to come out and visit the clinic.”

There aren’t many nonprofits in Hawaii providing direct medical care in the field for the unsheltered, she added, and by doing so, the Street Medicine team “really strengthens and builds trusting relationships with those individuals.”

“It really provides them more opportunities to offer more treatment to connect those individuals to social services that otherwise would not exist,” she said.

Gauze is wrapped around a patient’s wound during a Street Medicine clinic on Wednesday.

Outreach services started after Malama I Ke Ola addressed the needs of one homeless man last year who posed a danger to himself and was in dire need of care due to neglect, according to a news release.

After coordinating medical care and social services between May and July, the team successfully placed the patient in a group home where he remains today.

Yarborough said that the Street Medicine Program officially launched in July and an outreach RN was staffed to the team in October.

Malama I Ke Ola’s goal is to be patient-centered and trauma-informed, which means understanding that patients are coming from very difficult situations, she added.

“Just being understanding that access to health care is not equal, it’s only available to those that can advocate for themselves and come in and ask for what they need and express what they need, and then navigate the health care system,” she said.

In addition to wound and other on-site care, the street team has been able to facilitate health insurance, along with referrals for medical or behavioral health care.

“The community health workers are responsible for assisting the unsheltered to get connected to any resources that they need, so if that’s food, transportation, housing, they sort of help them make that call,” she said. “Or if it’s Medicaid applications, they help them do that or if they need to get registered and establish care somewhere, then they help them do that as well.”

While two members assist with applications and intake forms to establish care, the RN will provide wound care and assessments and coordinate primary care visits via telehealth through phones and tablets with a Malama provider with a same-day appointment, Yarborough said.

If a same-day appointment is not available, one will be scheduled.

Needs can vary by day, she added.

“I think especially for these times when we’re facing a pandemic, and eventually, post-pandemic issues, they’re really making an impact on stabilizing that population that already has challenges with their living environment and they also tend to have really complex health care issues,” Culley-Trotman said. “So I think the work they’re doing is just so dramatic.”

Medical case management and communication with the patient’s care team to provide the appropriate resources reduces the number of ER visits and hospitalization, according to Malama I Ke Ola.

The team has also been coordinating transportation for in-clinic visits when necessary.

“Visiting unsheltered homeless communities directly where they are located will allow care teams to immediately get a sense of that individual’s reality as well as their living conditions,” Cassie Savell, Malama I Ke Ola’s chief operating officer, said in the news release.

The health center also partners with Maui Rapid Response volunteers, who support frontline services and supplies, and the Maui Rescue Mission, which operates via a mobile unit containing a shower, a washer and dryer, toilet, clean clothes, Wi-Fi and other hygiene products.

Outreach workers meet at local beach parks and churches to offer different resources and aid for those in need.

“It kind of worked perfectly because we were already drawing a crowd and the crowd we were drawing desperately needed medical help,” said Scott Hansen, executive director of Maui Rescue Mission. “So just the synergy of it was perfect and it has resulted in lots of friends getting help but also more people coming to get help. It just gives you more reason to go to the outreach, so it’s been amazing actually.”

Both Hansen and Yarborough said Tuesday that a typical visit averages 20 to 30 individuals, with about 10 to 15 receiving some type of medical assistance, checkup, telehealth or referral.

In coordination with Maui Rescue Mission, the medical team meets from 12 to 4 p.m. Mondays at St. Theresa Church in Kihei, 10 a.m. to 2 p.m. Wednesdays and Fridays at Lahaina Baptist Church and 10 a.m. to 2 p.m. Thursdays at Kanaha Beach Park in Kahului.

On Tuesdays, when there aren’t outreach events, Yarborough said that the Malama medical team still conducts outreach on its own to check in with unsheltered patients.

The Street Medicine Program will be supported by the grant through the end of this year, but she’s hoping the program would eventually be able to sustain itself long term.

In the future, they aim to expand the program to reach more areas on Maui, like the North Shore, add a nurse practitioner to the team rather than rely fully on telehealth out in the field and provide more transportation assistance for patients who may need specialized care and services.

Malama I Ke Ola Health Center is supported by a Department of Health and Human Services Health Resources and Services Administration Health Center Program Award, and is also funded in part by grants from the state Department of Health and the Maui County Department of Housing and Human Concerns.

For more information about the Street Medicine Program, visit ccmaui.org/street-medicine-program/.

* Dakota Grossman can be reached at dgrossman@mauinews.com.

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